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What is Enrollment and WHY is everyone asking me for ALL this information?

September 5, 2017

 

Your first days at TTUHSC can be overwhelming. Besides the day to day stresses, the Department of Provider Payor Relations (PPR) is asking for all kinds of information, copies of diplomas, documents to be signed in ONLY blue ink, and requiring a million other signatures...

 

We bet you are asking W H Y?

 

In order for TTUHSC to be reimbursed for your services for patients with Medicare, Medicaid, and other Commercial Insurances, PPR Lead Specialists must enroll each healthcare practitioner into all contracted insurance programs. This is a lengthy and complicated process and is being processed simultaneously with the credentialing process. 

 

Wait…what’s credentialing?

 

All healthcare practitioners who wish to bill and receive reimbursement in-network must undergo a process of verification of education, training, experience, licenses, DEA, and driver’s license.

 

Holy paperwork.

 

TTUHSC PPR Lead Specialists are here to make the process as seamless as possible. 

 

This is what our enrollment team takes care of for our new healthcare providers:

 

1) Once your initial PPR enrollment packet is complete and all attachments are current, a provider is enrolled with Medicare. Lead Specialists must provide Medicare with details and copies of medical school information, board certifications (if applicable), licenses, DEA information, and contact information. Medicare and Medicaid perform their own credentialing process. Their process should be completed within 45-60 days.

 

2) TTUHSC contracted commercial payors are considered delegated. Then they accept the TTUHSC/UMC credentialing process and confirm with bi-yearly audits. Each payor is sent a spreadsheet with the same information requested by Medicare.

 

3) Our team confirms receipts and obtains your effective dates with the payors. After enrollment is complete, PPR maintains enrollment information with all payors by processing re-enrollments with Medicare and Medicaid. At that time, PPR will most likely request updated licenses, DEA information, driver’s license, etc. to keep everything up-to-date. 

 

Overwhelming process isn’t it? We want our TTUHSC Providers to know that we are on YOUR SIDE, and are always here to help or point you in the right direction during your first few days, weeks, months, and years. 

 

HELPFUL TIP: Is there a way to save all your paperwork in one place? Yes, there is. 

 

 

CAQH.org

https://www.caqh.org/ 

This website allows healthcare practitioners to streamline the redundant requests and maintain current information. After information is loaded and uploaded to CAQH, you will be asked to attest once every six months in addition to updating any expired licenses, DEA etc.  In two years when you are asked for re-credentialing information, simply log into CAQH, attest and print.

 

 

 

 

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